CORK Bibliography: Cognitve-Behvavioral Therapy

26 citations. January 2009 to present

Prepared: March 2010

Baker AL; Kavanagh DJ; Kay-Lambkin FJ; Hunt SA; Lewin TJ; Carr VJ; Connolly J. Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems: Short-term outcome. Addiction 105(1): 87-99, 2010. (24 refs.)

Aims: Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone. The present study (Depression and Alcohol Integrated and Single-focused Interventions; DAISI) aimed to compare the effectiveness of brief intervention, single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems. Methods: Participants (n = 284) with current depressive symptoms and hazardous alcohol use were assessed and randomly allocated to one of four individually delivered interventions: (i) a brief intervention only (single 90-minute session) with an integrated focus on depression and alcohol, or followed by a further nine 1-hour sessions with (ii) an alcohol focus; (iii) a depression focus; or (iv) an integrated focus. Follow-up assessments occurred 18 weeks after baseline. Results: Compared with the brief intervention, 10 sessions were associated with greater reductions in average drinks per week, average drinking days per week and maximum consumption on 1 day. No difference in duration of treatment was found for depression outcomes. Compared with single-focused interventions, integrated treatment was associated with a greater reduction in drinking days and level of depression. For men, the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning. Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment. Conclusions: Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems, at least in the short term. Gender differences between single-focused depression and alcohol treatments warrant further study.

Baker A; Turner A; Kay-Lambkin FJ; Lewin TJ. The long and the short of treatments for alcohol or cannabis misuse among people with severe mental disorders. Addictive Behaviors 34(10, Special Issue): 852-858, 2009. (45 refs.)

Substance misuse among people with severe mental disorders is very common and has been associated with a number of adverse outcomes. Most trials among people with severe mental disorders have reported general substance misuse outcomes and have argued that longer treatments are likely to be more effective. Such studies have not specifically compared intervention effectiveness for alcohol vs. cannabis misuse. The present paper reports findings from a synthesis of datasets from three randomized controlled trials (N=248) comparing brief (1-session advice or motivational interviewing, MI) and extended (10 sessions MI/cognitive-behaviour therapy; CBT) interventions for substance misuse among people with psychosis or major depression and outcomes are reported separately for alcohol and cannabis use. Whilst there were comparable rates of reduction in alcohol consumption for the BI and intensive MI/CBT, BI tended to be associated with less reduction in cannabis use. A stepped care approach for substance misuse in people with severe mental disorders may help to improve cannabis outcomes, including monitoring of both mental health and substance misuse domains. with interventions stepped up or down according to treatment response. Future studies should evaluate the effectiveness of stepped care approaches.

Bertholet N; Horton NJ; Saitz R. Improvements in readiness to change and drinking in primary care patients with unhealthy alcohol use: a prospective study. BMC Public Health 9(article 101), 2009

Background: The course of alcohol consumption and cognitive dimensions of behavior change (readiness to change, importance of changing and confidence in ability to change) in primary care patients are not well described. The objective of the study was to determine changes in readiness, importance and confidence after a primary care visit, and 6-month improvements in both drinking and cognitive dimensions of behavior change, in patients with unhealthy alcohol use. Methods: Prospective cohort study of patients with unhealthy alcohol use visiting primary care physicians, with repeated assessments of readiness, importance, and confidence ( visual analogue scale (VAS), score range 1-10 points). Improvements 6 months later were defined as no unhealthy alcohol use or any increase in readiness, importance, or confidence. Regression models accounted for clustering by physician and adjusted for demographics, alcohol consumption and related problems, and discussion with the physician about alcohol. Results: From before to immediately after the primary care physician visit, patients (n = 173) had increases in readiness (mean +1.0 point), importance (+0.2), and confidence (+0.5) (all p < 0.002). In adjusted models, discussion with the physician about alcohol was associated with increased readiness (+0.8, p = 0.04). At 6 months, many participants had improvements in drinking or readiness (62%), drinking or importance (58%), or drinking or confidence (56%). Conclusion: Readiness, importance and confidence improve in many patients with unhealthy alcohol use immediately after a primary care visit. Six months after a visit, most patients have improvements in either drinking or these cognitive dimensions of behavior change.

Carroll KM; Ball SA; Martino S; Nich C; Babuscio TA; Rounsaville BJ. Enduring effects of a computer-assisted training program for cognitive behavioral therapy: A 6-month follow-up of CBT4CBT. Drug and Alcohol Dependence 100(1-2): 178-181, 2009. (18 refs.)

Objectives: To evaluate the durability of effects of a computer-assisted version of cognitive behavioral therapy (CBT) as treatment for substance dependence through a 6-month follow-up. Methods: Following a randomized clinical trial in which 73 individuals seeking outpatient treatment for substance dependence in an outpatient community setting were randomized to either standard treatment-as-usual (TAU) or TAU with 8 weeks of biweekly access to computer-based training for CBT (CBT4CBT), participants were interviewed 1, 3, and 6 months after the termination of study treatments. Results: Sixty of the 73 participants were reached for follow-up (82%); follow-up rates and availability of data were comparable across treatment conditions. Random regression analyses of use across time indicated significant differences between groups, such that those assigned to TAU increased their drug use across time while those assigned to CBT4CBT tended to improve slightly. The durability of the CBT4CBT effect remained even after controlling for treatment retention, treatment substance use outcomes, and exposure to other treatment during the follow-up period. Conclusions: Computerized CBT4CBT appears to have both short-term and enduring effects on drug use.

Davidson KM; Tyrer P; Tata P; Cooke D; Gumley A; Ford I. Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial. Psychological Medicine 39(4): 569-577, 2009. (29 refs.)

Background. Little information exists on treatment effectiveness in antisocial personality disorder (ASPD). We investigated the feasibility and effectiveness of carrying out a randomized controlled trial of cognitive behaviour therapy (CBT) in men with ASPD who were aggressive. Method. This was an exploratory two-centre, randomized controlled trial in a community setting. Fifty-two adult men with a diagnosis of ASPD, with acts of aggression in the 6 months prior to the study, were randomized to either treatment as usual (TAU) plus CBT, or usual treatment alone. Change over 12 months of follow-up was assessed in the occurrence of any act of aggression and also in terms of alcohol misuse, mental state, beliefs and social functioning. Results. The follow-up rate was 79%. At 12 months, both groups reported a decrease in the occurrence of any acts of verbal or physical aggression. Trends in the data, in favour of CBT, were noted for problematic drinking, social functioning and beliefs about others. Conclusions. CBT did not improve outcomes more than usual treatment for men with ASPD who are aggressive and living in the community in this exploratory study. However, the data suggest that a larger study is required to fully assess the effectiveness of CBT in reducing aggression, alcohol misuse and improving social functioning and view of others. It is feasible to carry out a rigorous randomized controlled trial in this group.

Deas D; Clark A. Current state of treatment for alcohol and other drug use disorders in adolescents. Alcohol Research & Health 32(1): 76-82, 2009. (20 refs.)

Over the past decade, treatment programs have been developed specifically for adolescents with alcohol and other drug (AOD) use disorders. The vast majority of these programs use psychosocial approaches, which can be further classified into family-based interventions and multisystemic therapy, motivational enhancement therapy, behavioral therapy, and cognitive-behavioral therapy. Outcome studies have evaluated the effectiveness of the different approaches. The results indicate that all of these strategies can improve an adolescents outcome on a variety of measures. Pharmacotherapy rarely is used in the treatment of adolescents with AOD use disorders, and existing studies only have assessed the effectiveness of agents aimed at treating coexisting psychiatric conditions. Future studies should use more consistent, state-of-the-art assessment instruments developed specifically for adolescents and also pay greater attention to an adolescent's developmental status and its impact on treatment outcome.

Hides L; Carroll S; Catania L; Cotton SM; Baker A; Scaffidi A et al. Outcomes of an integrated cognitive behaviour therapy (CBT) treatment program for co-occurring depression and substance misuse in young people. Journal of Affective Disorders 121(1-2): 169-174, 2010. (21 refs.)

Background: There are high rates of co-occurring depression among young people with substance use disorders. While there is preliminary evidence for the effectiveness of integrated cognitive behaviour therapy (CBT) in combination with antidepressants among alcohol and Substance dependent adolescents and adults with co-existing depression, 110 Studies have examined the effectiveness of integrated CBT interventions in the absence of pharmacotherapy. The aim of the current Study was to determine the outcomes of ail integrated CBT intervention for co-occurring depression and substance misuse in young people presenting to a mental health setting. Methods: Sixty young people (aged 15 to 25), with a DSM-IV diagnosis of Major Depressive Disorder and concurrent substance misuse (at least weekly use in the past month) or disorder were recruited from a public youth mental health service in Melbourne, Australia. Participants received 10 sessions of individual integrated CBT treatment delivered with case management over a 20-week period. Results: The intervention was associated with significant improvements in depression, anxiety, substance use, coping skills, depressive and substance use cognitions and functioning at mid(10 weeks) and post- (20 weeks) treatment. These changes were maintained at 6 months follow-up (44 weeks). Conclusions: These results provide preliminary evidence for the effectiveness of the integrated CBT intervention in young people with co-occurring depression and substance misuse. Further studies using randomised controlled designs are required to determine its efficacy.

Hunt SA; Baker AL; Michie PT; Kavanagh DJ. Neurocognitive profiles of people with comorbid depression and alcohol use: Implications for psychological interventions. Addictive Behaviors 34(10, Special Issue): 878-886, 2009. (55 refs.)

Depression and alcohol use disorders frequently co-occur and are highly prevalent. Both conditions are known to impair cognitive functioning, yet research into the role of these impairments in response to Cognitive Behaviour Therapy (CBT) is limited. The purpose of the present study was to examine the relationship between baseline neuropsychological performance, severity of depressive symptoms and alcohol use disorders. Participants with current depression and hazardous alcohol use were functioning in the average range on all neuropsychological measures prior to treatment entry. Baseline measures of drinking severity and a range of cognitive functions were inversely correlated. After controlling for other baseline variables, superior baseline cognitive functioning predicted greater reductions in depression severity after 17 weeks. These predictive effects occurred across both brief and extended interventions. Findings suggest that improvement in depression following psychological treatment is enhanced by greater fluid reasoning ability and is predicted by executive functioning, regardless of the treatment length or problem focus.

Kealey KA; Ludman EJ; Marek PM; Mann SL; Bricker JB; Peterson AV. Design and implementation of an effective telephone counseling intervention for adolescent smoking cessation. Journal of The National Cancer Institute 101(20): 1393-1405, 2009. (85 refs.)

Effective smoking cessation for youth is urgently needed, but the literature guiding such efforts is nascent. We evaluated the implementation of a proactive intervention for adolescent smoking cessation that incorporated motivational interviewing (MI) and cognitive behavioral skills training (CBST). We proactively identified 1058 smokers via classroom survey of enrolled juniors in 25 experimental high schools. After parental consent was obtained, trained counselors telephoned participants to invite their participation and deliver personalized smoking cessation counseling that combined MI and CBST. Implementation quality was assessed via weekly supervision of counselors, monitoring of counselor adherence to protocol via review of 5% of each counselor's calls, and formal evaluation of counselor fidelity to MI via review of a random sample of 19.8% of counseling calls using the Motivational Interviewing Treatment Integrity Code. Among identified smokers, 948 (89.6%) were eligible for intervention by age (>= 18 years) or parental consent, 736 (70%) agreed to participate in telephone counseling, 691 (65%) completed one or more counseling calls, and 499 (47%) completed all planned calls. Telephone delivery of the personalized MI and CBST counseling intervention to a general population of adolescents was done with greater than 90% adherence to the intervention protocol. Review of the random sample of counselors' calls demonstrated that more than 85% of counselors' calls met or exceeded benchmark scores for four of six evaluated behaviors: MI spirit (99.1%), empathy (96.2%), ratio of reflections to questions (97.2%), and MI adherent (85.7%). An effective proactive telephone counseling intervention consisting of MI and CBST can be successfully implemented with reach and fidelity in a general population of adolescent smokers.

Kushner MG; Sletten S; Donahue C; Thuras P; Maurer E; Schneider A et al. Cognitive-behavioral therapy for panic disorder in patients being treated for alcohol dependence: Moderating effects of alcohol outcome expectancies. Addictive Behaviors 34(6-7): 554-560, 2009. (37 refs.)

Anxiety disorders commonly co-occur with alcohol use disorders and reliably mark a poor response to substance abuse treatment. However, treating a co-occurring anxiety disorder does not reliably improve substance abuse treatment outcomes. Failure to account for individual differences in the functional dynamic between anxiety symptoms and drinking behavior might impede the progress and clarity of this research program. For example, while both theory and research point to the moderating role of tension-reduction alcohol outcome expectancies (TR-AOEs) in the association between anxiety symptoms and alcohol use, relevant treatment studies have not typically modeled TR-AOE effects. We examined the impact: of a hybrid cognitive-behavioral therapy (H-CBT) treatment for panic disorder (independent variable) on response to a community-based alcohol dependence treatment program (dependent variable) in patients with higher vs. lower TR-AOEs (moderator). The H-CBT treatment was generally effective in relieving participants' panic symptoms relative to controls. However, TR-AOEs interacted with study cohort (H-CBT vs. control) in predicting response to substance abuse treatment. As expected, the H-CBT was most effective in improving alcohol use outcomes among those with the highest TR-AOEs. The study's primary methodological limitations are related to the quasi-experimental design employed.

Litt MD; Kadden RM; Kabela-Cormier E. Individualized assessment and treatment program for alcohol dependence: Results of an initial study to train coping skills. Addiction 104(11): 1837-1848, 2009. (27 refs.)

Aims: Cognitive-behavioral treatments (CBT) are among the most popular interventions offered for alcohol and other substance use disorders, but it is not clear how they achieve their effects. CBT is purported to exert its beneficial effects by altering coping skills, but data supporting coping changes as the mechanism of action are mixed. The purpose of this pilot study was to test a treatment in which coping skills were trained in a highly individualized way, allowing us to determine if such training would result in an effective treatment. Design: Participants were assigned randomly to a comprehensive packaged CBT program (PCBT), or to an individualized assessment and treatment program (IATP). The IATP program employed experience sampling via cellphone to assess coping skills prior to treatment, and provided therapists with a detailed understanding of patients' coping strengths and deficits. Setting: Out-patient treatment. Participants: A total of 110 alcohol-dependent men and women. Measurements: Participants in both conditions completed experience sampling of situations, drinking and coping efforts prior to, and following, 12 weeks of treatment. Time-line follow-back procedures were also used to record drinking at baseline and post-treatment. Findings: IATP yielded higher proportion of days abstinent (PDA) at post-treatment (P < 0.05) than did PCBT, and equivalent heavy drinking days. IATP also elicited more momentary coping responses and less drinking in high-risk situations, as recorded by experience sampling at post-treatment. Post-treatment coping response rates were associated with decreases in drinking. Conclusions: The IATP approach was more successful than PCBT at training adaptive coping responses for use in situations presenting a high risk for drinking. The highly individualized IATP approach may prove to be an effective treatment strategy for alcohol-dependent patients.

Longabaugh R; Wirtz PW; Gulliver SB; Davidson D. Extended naltrexone and broad spectrum treatment or motivational enhancement therapy. Psychopharmacology 206(3): 367-376, 2009. (50 refs.)

Randomized clinical trials on the effectiveness of naltrexone (NTX) in the treatment of alcohol dependence have produced conflicting results. One possible explanation for these discrepancies may lie in the various psychosocial treatments for which NTX is an adjunct. The goal of this study was to examine the interplay between psychosocial treatment and duration of NTX. One hundred and seventy-four alcohol-dependent outpatients participated in a double-blind trial where they were randomly assigned to 12 vs. 24 weeks NTX duration and to one of two psychosocial treatments: motivational enhancement therapy (MET) and broad spectrum treatment (BST), a cognitive behavioral therapy tailored to the patient's specific needs. After an initial 12-week period of NTX and psychosocial treatment, half of each psychotherapy condition was assigned to continue NTX for an additional 12 weeks while the other half was assigned to placebo. Patient drinking outcomes were measured for the year following treatment completion. It was hypothesized that the combination of extended duration of NTX and the moderate intensity of BST would be predictive of longer time to a first heavy drinking day than any of the three alternative combinations: MET with short or extended NTX administration or BST with short NTX administration. The median time to first drink and time to first heavy drinking day were found to be significantly longer for patients who received BST and extended NTX than for patients in the other three groups. These results may suggest that the kind of psychosocial treatment delivered in combination with duration of NTX administration may partially explain the inconsistent findings regarding the efficacy of NTX in the treatment of alcohol dependence.

Magill M; Ray LA. Cognitive-behavioral treatment with adult alcohol and illicit drug users: A meta-analysis of randomized controlled trials. (review). Journal of Studies on Alcohol and Drugs 70(4): 516-527, 2009. (112 refs.)

Objective: This meta-analysis examined 53 controlled trials of cognitive-behavioral treatment (CBT) for adults diagnosed with alcohol- or illicit-drug-use disorders. The aims were to provide an overall picture of CBT treatment efficacy and to identify client or treatment factors predictive of CBT effect magnitude. Method: The inverse variance weighted effect size (Hedges'g) was calculated for each study and pooled using fixed and random effects methods. Potential study-level moderators were assessed in subgroup analyses by primary drug, type of CBT, and type of comparison condition. In addition, seven client and treatment variables were examined in meta-regression analyses. Results: Across studies, CBT produced a small but statistically significant treatment effect (g = 0. 154, p <.005). The pooled effect was somewhat lower at 6-9 months (g = 0.115, p < .005) and continued to diminish at 12-month follow-up (g = 0.096, p < .05). The effect of CBT was largest in marijuana studies (g = 0.513, p < .005) and in studies with a no-treatment control as the comparison condition (g = 0.796, p < .005). Metaregression analyses indicated that the percentage of female participants was positively associated and the number of treatment sessions was negatively associated with effect size. Conclusions: The findings demonstrate the utility of CBT across a large and diverse sample of studies and under rigorous conditions for establishing efficacy. CBT effects were strongest with marijuana users, when CBT was compared with no treatment, and may be larger with women than with men and when delivered in a brief format.

McGovern MP; Lambert-Harris C; Acquilano S; Xie HY; Alterman AI; Weiss RD. A cognitive behavioral therapy for co-occurring substance use and posttraumatic stress disorders. Addictive Behaviors 34(10, Special Issue): 892-897, 2009. (44 refs.)

Co-occurring posttraumatic stress disorder (PTSD) is prevalent in addiction treatment programs and a risk factor for negative outcomes. Although interventions have been developed to address substance use and PTSD, treatment options are needed that are effective, well tolerated by patients, and potentially integrated with existing program services. This paper describes a cognitive behavioral therapy (CBT) for PTSD that was adapted from a treatment for persons with severe mental illnesses and PTSD in community mental health settings. The new adaptation is for patients in community addiction treatment with co-occurring PTSD and substance use disorders. In this study, 5 community therapists delivered the CBT for PTSD. Outcome data are available on 11 patients who were assessed at baseline, post-CBT treatment. and at a 3-month follow-up post-treatment. Primary outcomes were substance use, PTSD severity, and retention, of which all were favorable for patients receiving the CBT for PTSD.

Mckay JR; Lynch KG; Coviello D; Morrison R; Cary MS; Skalina L et al. Randomized trial of continuing care enhancements for cocaine-dependent patients following initial engagement. Journal of Consulting and Clinical Psychology 78(1): 111-120, 2010. (57 refs.)

Objective: The effects of cognitive-behavioral relapse prevention (RP), contingency management (CM), and their combination (CM + RP) were evaluated in a randomized trial with 100 cocaine-dependent patients (58% female, 89% African American) who were engaged in treatment for at least 2 weeks and had an average of 44 days of abstinence at baseline. Method: The participants were from intensive outpatient programs, which provide 10 hr per week of group counseling. The CM protocol provided gift certificates (maximum value $1,150; mean received = $740) for cocaine-free urines over 12 weeks on an escalating reinforcement schedule, and weekly individual RP sessions were offered for up to 20 weeks. Average number of RP sessions attended was 3 in RP and 13 in CM + RP. Results: Generalizing estimation equation analyses over 18 months postrandomization showed significant effects for CM (but not RP) on urine toxicology and self-reported cocaine use (p = .05), with no significant CM x RP interactions. Secondary analyses indicated CM + RP produced better cocaine urine toxicology outcomes at 6 months than treatment as usual, odds ratio [OR] = 3.96 (1.33, 11.80), p < .01, and RP, OR = 4.89 (1.51, 15.86), p < .01, and produced better cocaine urine toxicology outcomes at 9 months than treatment as usual, OR = 4.21 (1.37, 12.88), p < .01, and RP, OR = 4.24 (1.32, 13.65), p < .01. Trends also favored CM + RP over CM at 6 months, OR = 2.93 (0.94, 9.07), p = .06, and 9 months, OR = 2.93 (0.94, 9.10), p = .06. Differences between the conditions were not significant after 9 months. Conclusions: These results suggest CM can improve outcomes in cocaine-dependent patients in intensive outpatient programs who have achieved initial engagement, particularly when it is combined with RP.

Mogg D; Levy M. Moving beyond non-engagement on regulated needle-syringe exchange programs in Australian prisons. Harm Reduction Journal 6(7), 2009. (23 refs.)

Background: Australia is at a fork in the road with the possibility of a needle-syringe exchange program (NSP) to be introduced at the new prison in the ACT. However, the current situation is characterised by non-engagement from major stakeholders. We explore why informed discussion will not be enough to convince prison officers, policy makers and the wider community of the benefits of prison-based NSPs. Other methods of engagement and communication will be proposed - in that may provide avenues for "breakthrough". Methods: A review of the literature on needle-syringe exchanges and harm reduction strategies within the context of prisons and prisoner health was conducted. Literature on strategies to change attitudes and move beyond intractable situations was also consulted. In addition, one author, DM, conducted a two-hour interview with an ex-prison officer. Results: No studies were found which investigated the potential efficacy of interventions to modify attitudes or behaviours in the specific context of introducing an NSP into a prison. Nonetheless, several theories were identified which may explain the failure of informed discussion alone to create change in this situation and may therefore lead to suggestions for engagement and communication to move towards a resolution. Discussion: Cognitive-behavioural therapy highlights the importance of individual cognitions and how they shape behaviours in any change campaign. Social identity theory emphasizes changes to social processes that may open the prison officer workforce to change. Peace studies also suggests socialization strategies such as observing an established and effective prison-based needle-syringe exchange. Social marketing provides suggestions on how to sell an exchange to ensuring the benefits are framed to outweigh the costs. Conclusion: Psychology, peace studies and social marketing all agree people's views must be carefully collected and analysed if people are going to be convinced to consider and discuss the issue. By understanding the views and their underlying motivations of those who oppose NSPs, it will be far easier to influence these views. Furthermore, involving all stakeholders, especially prison authorities, will help create a sense of ownership of a solution and therefore increase the chances of that solution succeeding.

Pull CB. Current empirical status of acceptance and commitment therapy. Current Opinion in Psychiatry 22(1): 55-60, 2009. (27 refs.)

Purpose of review: Acceptance and commitment therapy (ACT) is one of the several psychotherapies that have been described as 'third wave' cognitive behavioral therapies (CBTs). The present editorial review examines the current status of ACT with a focus on previous reviews, a meta-analysis and new studies that have been published between January 2006 and August 2008. Recent findings: Recent studies on ACT suggest that ACT may be effective for a variety of disorders, including several anxiety disorders, depression, pain, trichotillomania, psychotic disorder, drug abuse and the management of epilepsy and diabetes. Summary: The available evidence suggests that ACT works through different processes than active treatment comparisons, including traditional CBT. Although currently available data are promising, there is, however, a need for more well controlled studies to verify whether ACT is generally as or more effective than other active treatments across the range of problems examined.

Ramon JM; Bruguera E. Real world study to evaluate the effectiveness of varenicline and cognitive-behavioural interventions for smoking cessation. International Journal of Environmental Research and Public Health 6(4): 1530-1538, 2009. (17 refs.)

A prospective pragmatic interventional study was conducted to evaluate the effectiveness of varenicline for smoking cessation among a cohort of motivated smokers attending two smoking cessation clinics. Smokers between 18 and 65 years who had smoked 10 or more cigarettes per day were included. All participants received cognitive-behavioural varenicline according to approved dose and prescriptions. Continuous abstinence, validated by exhaled CO levels, was assessed in each control. A total of 264 smokers - 155 males (58.7%) and 109 females (41.3%) - were included. Mean age was 43.7, amount smoked was 23 cigarettes per day and 61.4% had at least one prior attempt to quit. The continuous abstinence rate at end of treatment (12 wks) was 58.3%. Conclusions: varenicline and cognitive-behavioural intervention are effective for smoking cessation with high continuous abstinence rates when are used in a clinical setting.

Roberts-Lewis AC; Parker S; Welch C; Wall A; Wiggins P. Evaluating the cognitive and behavioral outcomes of incarcerated adolescent females receiving substance abuse treatment: A pilot study. Journal of Child & Adolescent Substance Abuse 18(2): 157-171, 2009. (26 refs.)

The purpose of this pilot study was to evaluate the effectiveness of a cognitive-behavioral approach in changing the behavioral and cognitive skills of incarcerated girls participating in a substance abuse treatment program. A repeated measures design was used. The findings of this study revealed that the behaviors (i.e., self-monitoring, self-control, etc.) and cognitive skills (i.e., cognitive concentration, consequential thinking, etc.) of participants improved significantly. Research and practice implications are discussed.

Schmitz JM; Lindsay JA; Green CE; Herin DV; Stotts AL; Moeller FG. High-dose naltrexone therapy for cocaine-alcohol dependence. American Journal on Addictions 18(5): 356-362, 2009. (36 refs.)

This randomized, double-blind, placebo-controlled study compared the effects of high-dose (100 mg/d) naltrexone versus placebo in a sample of 87 randomized subjects with both cocaine and alcohol dependence. Medication conditions were crossed with two behavioral therapy platforms that examined whether adding contingency management (CM) that targeted cocaine abstinence would enhance naltrexone effects compared to cognitive behavioral therapy (CBT) without CM. Primary outcome measures for cocaine (urine screens) and alcohol use (timeline followback) were collected thrice-weekly during 12 weeks of treatment. Retention in treatment and medication compliance rates were low. Rates of cocaine use and drinks per day did not differ between treatment groups; however naltrexone did reduce frequency of heavy drinking days, as did CBT without CM. Notably, adding CM to CBT did not enhance treatment outcomes. These weak findings suggest that pharmacological and behavioral interventions that have shown efficacy in the treatment of a single drug dependence disorder may not provide the coverage needed when targeting dual drug dependence.

Sobell LC; Sobell MB; Agrawal S. Randomized controlled trial of a cognitive-behavioral motivational intervention in a group versus individual format for substance use disorders. Psychology of Addictive Behaviors 23(4): 672-683, 2009. (55 refs.)

Although group therapy is widely used for individuals with substance use disorders (SUDs), randomized clinical trials (RCTs) comparing the same treatment in a group versus individual format are rare. This paper presents the results of a RCT comparing guided self-change (GSC) treatment, a cognitive-behavioral motivational intervention, conducted in a group versus individual format with 212 alcohol abusers and 52 drug abusers who voluntarily sought outpatient treatment. Treatment outcomes demonstrated significant and large reductions in clients' alcohol and drug use during treatment and at the 12-month follow-up, with no significant differences between the group and individual therapy conditions. A therapist time ratio analysis found that it took 41.4% less therapist time to treat clients using the group versus the individual format. Participants' end-of-treatment group cohesion scores characterized the groups as having high engagement, low levels of interpersonal conflict, and low avoidance of group work, all desirable group characteristics. These findings suggest that the GSC treatment model was effectively integrated into a brief group treatment format. Health care cost containment compels further evaluations of the efficacy of group treatments for SUDs.

Spada MM; Caselli G; Wells A. Metacognitions as a predictor of drinking status and level of alcohol use following CBT in problem drinkers: A prospective study. Behaviour Research and Therapy 47(10): 882-886, 2009. (31 refs.)

This study investigated the role of negative emotions and metacognitions in predicting problem drinkers' drinking status (absence or presence of drinking) and level of weekly alcohol use at 3, 6 and 12 months after a course of treatment. A total of 70 problem drinkers with a DSM-IV diagnosis of alcohol abuse participated in the study. Depressive symptoms were assessed with the Beck Depression Inventory and symptoms of anxiety were measured with the state anxiety sub-scale of the State-Trait Anxiety Inventory. Metacognitions were measured with the Meta-Cognitions Questionnaire. Results indicated that beliefs about need to control thoughts predicted: (1) drinking status at 3 and 6 months; and (2) level of weekly alcohol use at 3, 6 and 12 months. The contribution of metacognition was independent of negative emotions and initial level of weekly alcohol use. The results support the role of metacognition in problem drinking. Given that metacognitions are a possible risk factor for drinking status and level of weekly alcohol use it is suggested that treatment for problem drinking could target this variable.

Strong DR; Kahler CW; Leventhal AM; Abrantes AM; Lloyd-Richardson E; Niaura R et al. Impact of bupropion and cognitive-behavioral treatment for depression on positive affect, negative affect, and urges to smoke during cessation treatment. Nicotine & Tobacco Research 11(10): 1142-1153, 2009. (58 refs.)

Bupropion and cognitive-behavioral treatment (CBT) for depression have been used as components of treatments designed to alleviate affective disturbance during smoking cessation. Studies of treatment-related changes in precessation affect or urges to smoke are needed to evaluate the proposed mechanisms of these treatments. The present report examines affective trajectories and urges to smoke prior to, on quit day, and after quitting in a sample of 524 smokers randomized to receive bupropion versus placebo and CBT versus standard smoking cessation CBT. Bupropion and/or CBT did not affect the observed decreases in positive affect and increases in negative affect prior to cessation. However, on quit day, observed levels of negative affect and urges to smoke were diminished significantly among individuals receiving bupropion. Decreases in positive affect prior to quitting, lower levels of positive affect, and increased levels of negative affect and urges to smoke on quit day were each related to higher risk of smoking lapse. Depression proneness was an independent predictor of lower positive affect and higher negative affect but did not moderate the effects of bupropion on outcomes. In mediational analyses, the effect of bupropion was accounted for in part by lower negative affect and urges to smoke on quit day. Results support the efficacy of bupropion in reducing relapse risk associated with urges to smoke and negative affect and suggest the need to better understand the role of low positive affect as a risk factor for early lapse.

Walters D; Connor JP; Feeney GFX; Young RM. The cost effectiveness of naltrexone added to cognitive-behavioral therapy in the treatment of alcohol dependence. Journal of Addictive Diseases 28(2): 137-144, 2009. (42 refs.)

The purpose of this study was to evaluate the comparative cost of treating alcohol dependence with either cognitive behavioral therapy (CBT) alone or CBT combined with naltrexone (CBT+naltrexone). Two hundred ninety-eight outpatients dependent on alcohol who were consecutively treated for alcohol dependence participated in this study. One hundred seven (36%) patients received adjunctive pharmacotherapy (CBT+naltrexone). The Drug Abuse Treatment Cost Analysis Program was used to estimate treatment costs. Adjunctive pharmacotherapy (CBT+naltrexone) introduced an additional treatment cost and was 54% more expensive than CBT alone. When treatment abstinence rates (36.1% CBT; 62.6% CBT+naltrexone) were applied to cost effectiveness ratios, CBT+naltrexone demonstrated an advantage over CBT alone. There were no differences between groups on a preference-based health measure (SF-6D). In this treatment center, to achieve 100 abstainers over a 12-week program, 280 patients require CBT compared with 160 CBT+naltrexone. The dominant choice was CBT+naltrexone based on modest economic advantages and significant efficiencies in the numbers needed to treat.

Weingardt KR; Cucciare MA; Bellotti C; Lai WP. A randomized trial comparing two models of web-based training in cognitive-behavioral therapy for substance abuse counselors. Journal of Substance Abuse Treatment 37(3): 219-227, 2009. (29 refs.)

This study compared training outcomes obtained by 147 substance abuse counselors who completed eight self-paced online modules on cognitive-behavioral therapy (CBT) and attended a series of four weekly group supervision sessions using Web conferencing software. Participants were randomly assigned to two conditions that systematically varied the degree to which they explicitly promoted adherence to the CBT protocol and the degree of control that they afforded participants over the sequence and relative emphasis of the training curriculum. Outcomes were assessed at baseline and immediately following training. Counselors in both conditions demonstrated similar improvements in CBT knowledge and self-efficacy. Counselors in the low-fidelity condition demonstrated greater improvement on one of three measures of job-related burnout when compared to the high-fidelity condition. The study concludes that it is feasible to implement a technology-based training intervention with a geographically diverse sample of practitioners, that two training conditions applied to these samples of real-world counselors do not produce statistically or clinically significant differences in knowledge or self-efficacy, and that further research is needed to evaluate how a flexible training model may influence clinician behavior and patient outcomes.

Whiteside U; Cronce JM; Pedersen ER; Larimer ME. Brief motivational feedback for college students and adolescents: A harm reduction approach. Journal of Clinical Psychology 66(2): 150-163, 2010. (20 refs.)

Alcohol consumption and its attendant problems are prevalent among adolescents and young adult college students. Harm reduction has been found efficacious with heavy drinking adolescents and college students. These harm reduction approaches do not demand abstinence and are designed to meet the individual where he or she is in the change process. The authors present a case illustration of a harm reduction intervention, the Brief Alcohol Screening and Intervention for College Students (BASICS), with a heavy-drinking female college student experiencing significant problems as a result of her drinking. BASICS is conducted in a motivational interviewing style and includes cognitive-behavioral skills training and personalized feedback.